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For Smallest Preemies, Long-Term Outlook Can Be Bleak

Problems persist at school age for 41 percent, study finds

WEDNESDAY, Jan. 5, 2005 (HealthDayNews) -- Babies born prematurely enter the world at high risk for neurological and developmental disabilities, and now a new study finds that those impairments persist to school age and are more common than previously believed.

British researchers followed 241 children who had been born at 25 weeks or earlier, tracking their performance at age 6 when they had entered school, and compared them to a control group of 160 classmates who were born at full-term. The researchers had previously evaluated the preemies at 30 months of age.

Among the children who were born prematurely, 41 percent had general cognitive deficits while only 2 percent of their full-term classmates did, the researchers report in the Jan. 6 issue of the New England Journal of Medicine. The researchers used standardized cognitive and neurological tests to make their assessments.

Among children with severe disability at 30 months, 86 percent still had moderate to severe disability at age 6. And many children who had no appreciable disability at 30 months showed evidence of disability at age 6.

The level of impairment, the authors write, is greater than the level recognized with just the use of standardized norms.

The research breaks new ground, said study co-author Dieter Wolke, a professor of life span psychology at the University of Bristol in England.

"There have been previous follow-up studies on preterm babies," he said, but the current study is believed to be the first to use classroom controls. "Only this way can the true outcome of all births below 26 weeks' gestation can be judged," he explained.

The results, Wolke said, provide "clear evidence that care for these children and their families has to continue after discharge. Huge amounts are invested to have them survive; similar amounts may be required to ensure adequate quality of life for the family."

About 470,000 babies are born prematurely in the United States every year, said Dr. Scott Berns, vice president for chapter programs at the March of Dimes. Premature births are those in which the baby is born at less than 37 weeks of gestation. A full-term pregnancy is 40 weeks.

He called the new study "very informative to all of us, and in particular to the health-care providers who are taking care of these babies."

"People ask this question all the time: 'What are the long-term consequences of preterm birth?'" Berns said. The latest research, he added, is probably the largest group ever studied of extremely premature babies.

"This study is very important because it emphasizes the fact that there are these long-term consequences," he said.

"This underscores the fact that these premature babies have long-term health problems," Berns said. Early intervention is crucial to recognize problems of cognition, motor difficulties, and hearing and vision problems, he said, all of which can affect preemies.

Preventing preterm birth when possible is also crucial, Berns said. Women with a history of preterm birth are more likely to deliver another premature baby, as are women carrying twins or other multiples.

But many women who deliver prematurely have no known risk factors. There are some ways to reduce the risk, according to the March of Dimes. Women should get prenatal care as soon as they think they are pregnant, and should not smoke or drink alcohol while pregnant.

More information

To find out how to reduce the risk of delivering a premature baby, visit the March of Dimes.

SOURCES: Scott Berns, M.D., M.P.H., vice president, chapter programs, March of Dimes, White Plains, N.Y.; Dieter Wolke, Ph.D., professor, lifespan psychology, University of Bristol, England, and scientific director, Jacobs Foundation, Zurich, Switzerland; Jan. 6, 2005, New England Journal of Medicine
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